New Medicaid online enrollment puts Oklahoma out in front

“Is there anyone here from Oklahoma?”

I was at a national conference of health care policy experts and advocates last month when the morning’s plenary speaker, Cindy Mann, Medicaid Director for the Centers for Medicare and Medicaid Services, posed that ominous question. “Uh-oh. What have we done this time?”, I wondered, as I tentatively lifted my hand.  But this time, Oklahoma was being singled out for major praise, not ridicule. What Oklahoma had done that had Mann and several others at the conference gushing was launch a new streamlined enrollment system for the Medicaid program that may be the most user-friendly in the nation – and that positions Oklahoma at the front of the pack as states face the challenges and opportunities of implementing health care reform in the coming years.

Until the launch of the new enrollment system, applicants for SoonerCare health insurance coverage, the state’s Medicaid program, submitted a paper application to the Oklahoma Department of Human Services (DHS) during regular office working hours. In most cases an eligibility determination would be made 20 to 30 days later after information was entered into the agency’s legacy mainframe computer and verified. Policies and procedures were handled at least slightly differently in each county office and by each caseworker, and the client numbering and tracking system was prone to errors.

The new online enrollment system, which is now operated by the Oklahoma Health Care Authority (OHCA), simplifies, standardizes, and expedites the process. Individuals can apply at any time from any computer, either on their own or with the assistance of trained community or state agency partners (For the computer-shy, paper applications may still be submitted). As with an online tax return, the process is logic-driven and rules-based, ensuring that applicants provide all required information on family members, income, health status, and the like needed to make a determination. After the application is completed and submitted, eligibility is determined in real-time and those found to be eligible are enrolled in the program immediately and automatically (contingent on some follow-up verification of information). Once they are enrolled, applicants can review their status and update their information online at any time, in many cases doing away with the need for the state to send out annual eligibility redetermination letters. This process empowers and equips the applicants/members to control their own household data.

The online enrollment system has been in development since late 2007; after data on all current recipients – some 700,000 individuals – was transferred over from the old system, the new system launched September 7, 2010. When I spoke with Richard Evans, OHCA’s Eligibility Automation and Data Integrity Manager (a title itself in need of some streamlining), he reported that since the system’s launch, more than half of new applications have come directly through the online enrollment system; the remainder are part of a common benefits application submitted to the Oklahoma Department of Human Services. One limitation of the new system: While SoonerCare applicants are informed that they may be eligible for benefits administered by DHS, such as food stamps or child care subsidies, and provided information on how to apply, OHCA and DHS are not directly sharing and transferring data.

The new system moves Oklahoma towards a single comprehensive application for public medical programs. Currently, the online enrollment system is able to process SoonerCare applications for children, families, and pregnant women, as well as for adults who may be eligible only for family planning or behavioral health services in a single application. The scheduled Phase II  online enrollment would expand the application to include the Oklahoma Care program, which provides coverage for Breast and Cervical Cancer, the Insure Oklahoma premium assistance program, and the WIC nutrition program administered by the state Health Department.

As the national attention at my conference indicates, the new system puts Oklahoma out in front among states in creating a simplified, integrated and consumer-controlled enrollment process. It should also put Oklahoma in an ideal situation for moving forward with health care reform. Under the Affordable Care Act, states will have primary responsibility for creating integrated, consumer-focused systems to determine whether low- and moderate-income families are eligible for coverage under Medicaid (which will be expanded to include all adults up to 133 percent of the federal poverty level) or for tax credits to purchase private policies through the new Health Insurance Exchanges beginning in 2014. As Tricia Brooks discussed in this recent blog post, the federal government is committing significant resources to helping states develop enhanced eligibility systems that will be up to the task. Soon the federal government will select five states for Innovator Grants to design and implement the IT  infrastructure needed to operate Health Insurance Exchanges – bolstered by 100 percent federal funding. Based on the progress the state has already made with online enrollment, Oklahoma is believed to be a leading candidate to be one of the five successful states – assuming the new Governor and her administration sign off on the application. If Oklahoma does become a model for integrated and simplified enrollment across health care programs, many more of us may be quicker to raise our hands when Oklahoma is mentioned in national meetings in the years ahead.